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Halim:  Deep sedation charges utilize anesthesia time units (ATU).  No
WRVUs for these codes.  Ketamine, propofol, etomidate sedation would
be under deep sedation, and hence anesthesia codes.  You can look up
the formula for the ATUs but you get several up front and then one
additional ATU every 15 minutes.  This includes prep time, eval time,
and some time after conclusion of procedure until patient is stable to
be monitored by a nurse.  If you want to convert ATUs to WRVUs for
productivity or comp purposes, general consensus is that it is
roughtly 0.5 to 1.0 WRVUs for each ATU.  A common number that is used
is 0.6 WRVU per ATU.  Most procedures are in the range of 7 to 10
ATUs.  Payment for sedation is dependent on contacting.  If your group
has signed a medicaid contract that doesn't pay for it, then
non-payment should be expected.  In my community, the medicaid plans
do pay us for sedation because this has been included in the contracts
that we have with them.  They didn't pay initially, but once we find
out that a typical plan doesn't pay for something, we make sure it is
added to the next contract that we sign with them.  At least we try
very hard to do this, ideally.  Let me know if you need more info on
this.  Thanks, Loren
-- 
Loren G. Yamamoto, MD, MPH, MBA, FAAP, FACEP
Professor of Pediatrics, University of Hawaii John A. Burns School of Medicine
Emergency Medicine Director & Vice-Chief of Staff, Kapiolani Medical
Center For Women & Children


On Thu, Feb 14, 2013 at 8:35 AM, Halim Hennes
<[log in to unmask]> wrote:
> On a similar note I would like to know why Medicaid does not pay for EP provider sedation and looking at the guidance there is no RVU attached. I am in the process of taking the issue up with them and need some help. Will appreciate it hearing from people who manage to get approval from Medicaid. Thanks
>
>
> Halim Hennes
> Sent from my iPhone
>
> On Feb 14, 2013, at 9:26 AM, Doc Holiday <[log in to unmask]> wrote:
>
>> From: Fernando G Mendoza <[log in to unmask]> wrote:
>>> ...our Anesthesia Dept is again threatening to fight us on the use of Ketamine / Etomidate in the ED for procedural sedation. (Don't even mention Propofol!)
>> --> I have responded to this sort of theme on a number of occasions on ListServs (this one and a "grown up" one) and also in private conversations with North American EPs and PEPs. It has been some time since the last - I was hoping the whole issue was dying everywhere, now that in so many places even the "slow" folk are beginning to understand that EM is a specialty, not an experiment.
>> I also realise I am speaking from a country (UK) where this "battle" never took place, but I am aware of the main reason for why we did not have this battle to fight and I think that it's the key!
>> So why did our anaesthesia folk in the UK not fight this battle? Why did they not make rules about who could use propofol and how one should use ketamine and sedation, etc?
>> Well, they did!
>> It's only that, while they were shouting about it and banging tables, there was no-one else in the room!
>> We never asked them for their opinion about how to run any aspects of the ED, just like we did not ask the surgeons how to suture nor the cardiologists how to use a stethoscope nor the vascular surgeons on how to measure pulse rates nor the radiologists on ultrasound policy. Although most of them are as clever as we are, being physicians, we are fully within our rights to prescribe medications and use stethoscopes, ultrasound probes and orthopaedic casts.
>> So the main difference is not that they had nothing to say - it's that no-one cared!
>> I suspect YOUR problem is NOT the anaesthesia department - it's whoever is listening to them. Generally, it's some management people, I've been told. There is no point trying to "prove" your case with various resources from elsewhere. You should not be bringing evidence to a court case which has no right to be taking place!
>> I do have a solution, but it requires teamwork. The problem I often find in the USA is that managers use "compensation" as a tool to fragment and conquer the ED. If you all stand together and simply decline to hear/read anything about ED work other than what is said/written by board certified or otherwise experienced to the equivalent level EMERGENCY PHYSICIANS, then you should not need to hear/read something like this.
>> If you are not all prepared to stand up as one and put everything on the line for the sake of being able to practice to that very very high level to which you have been trained, then I have no solution to offer.
>> (BTW, this DOES mean that you SHOULD listen to your "adult" colleagues and they should listen to you - same specialty)
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                 http://listserv.brown.edu/ped-em-l.html
>
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html



-- 
Loren G. Yamamoto, MD, MPH, MBA, FAAP, FACEP
Professor of Pediatrics, University of Hawaii John A. Burns School of Medicine
Emergency Medicine Director & Vice-Chief of Staff, Kapiolani Medical
Center For Women & Children

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html